Provider Demographics
NPI:1700029030
Name:COLORADO COLLEGE COUNSELING CENTER
Entity Type:Organization
Organization Name:COLORADO COLLEGE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELING SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-389-6384
Mailing Address - Street 1:1106 N CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1355
Mailing Address - Country:US
Mailing Address - Phone:719-389-6384
Mailing Address - Fax:719-389-6928
Practice Address - Street 1:1106 N CASCADE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1355
Practice Address - Country:US
Practice Address - Phone:719-389-6384
Practice Address - Fax:719-389-6928
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE COLORADO COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2589101YP2500X
CO422101YP2500X
CO1569103TC0700X
CO2810103TC0700X
CO9890861041C0700X
CO9897751041C0700X
CO279762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty